Active NPI
Kevin Roger Sansom
- Pharmacist
- Bowling Green, KY
National Provider Identifier
1003429309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 021434
- Practice address
- 2385 Nashville Rd
Bowling Green, KY 42101-4144 - Phone
- (270) 393-8979
- NPI assigned
- Aug 26, 2020
- Last updated
- Aug 26, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 021434 | KY | Primary |
Addresses
Primary practice location
2385 Nashville Rd
Bowling Green, KY 42101-4144
Mailing address
833A Denzil Ave
Bowling Green, KY 42104-6552
Phone (901) 497-3674
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021434 | KY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
2385 Nashville Rd
Bowling Green, KY 42101
Phone (270) 393-8979
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598400000000",
"number": "1003429309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "833A DENZIL AVE",
"city": "BOWLING GREEN",
"state": "KY",
"postal_code": "421046552",
"telephone_number": "901-497-3674"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2385 NASHVILLE RD",
"city": "BOWLING GREEN",
"state": "KY",
"postal_code": "421014144",
"telephone_number": "270-393-8979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANSOM",
"first_name": "KEVIN",
"middle_name": "ROGER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-26",
"last_updated": "2020-08-26",
"certification_date": "2020-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "KY",
"license": "021434",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bowling Green, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.